{"id":55289,"date":"2026-04-15T07:07:10","date_gmt":"2026-04-15T07:07:10","guid":{"rendered":"https:\/\/www.europesays.com\/cz\/55289\/"},"modified":"2026-04-15T07:07:10","modified_gmt":"2026-04-15T07:07:10","slug":"hazard-se-zivoty-konci-vojtech-chce-udelat-tecku-za-trofejnimi-vykony-na-jatrech-ci-slinivce","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/cz\/55289\/","title":{"rendered":"Hazard se \u017eivoty kon\u010d\u00ed: Vojt\u011bch chce ud\u011blat te\u010dku za trofejn\u00edmi v\u00fdkony na j\u00e1trech \u010di slinivce"},"content":{"rendered":"

V\u00a0\u010cesku m\u00e1me st\u00e1le nemocnice, kter\u00e9 prov\u00e1d\u011bj\u00ed dv\u011b, t\u0159i resekce slinivky ro\u010dn\u011b. V\u00fdsledkem t\u011bchto trofejn\u00edch v\u00fdkon\u016f je hazard se \u017eivoty pacient\u016f. Ministerstvo te\u010f \u0159\u00edk\u00e1 jasn\u00e9 NE. Na z\u00e1klad\u011b chystan\u00fdch metodick\u00fdch pokyn\u016f maj\u00ed zdravotn\u00ed poji\u0161\u0165ovny nevyhovuj\u00edc\u00edm pracovi\u0161t\u00edm odsmlouvat resekce j\u00edcnu, jater a slinivky. Inkriminovan\u00e9 hospitalizace mimo centra nav\u00edc p\u0159\u00ed\u0161t\u00ed rok zaplat\u00ed jen z\u00a025 %. \u00a0<\/p>\n

O tom, \u017ee prov\u00e1d\u011bn\u00ed n\u011bkter\u00fdch onkochirurgick\u00fdch operac\u00ed na mal\u00fdch pracovi\u0161t\u00edch m\u00e1 prachmizern\u00e9 v\u00fdsledky a m\u011blo by skon\u010dit, se u\u017e mluv\u00ed n\u011bjakou dobu<\/a>. Nap\u0159\u00edklad standardizovan\u00e1 90denn\u00ed mortalita po resekci jater dos\u00e1hla mezi lety 2022\u20132024 na velkoobjemov\u00fdch pracovi\u0161t\u00edch 6,15 %, zat\u00edmco v nemocnic\u00edch s\u00a0m\u00e9n\u011b ne\u017e 20 operacemi ro\u010dn\u011b \u010dinila 11,76 %.<\/p>\n

U resekc\u00ed jater, slinivky a j\u00edcnu, kde m\u00e1 centralizace jednozna\u010dnou oporu v\u00a0zahrani\u010dn\u00edch datech, se ov\u0161em st\u00e1le p\u011btina v\u00fdkon\u016f prov\u00e1d\u00ed mimo velk\u00e1 pracovi\u0161t\u011b. S\u00a0t\u00edm chce nyn\u00ed ministerstvo zdravotnictv\u00ed skon\u010dit<\/a>. Jak? Na sv\u011bt\u011b u\u017e jsou dva metodick\u00e9 pokyny, podle nich\u017e se nemaj\u00ed prov\u00e1d\u011bt zm\u00edn\u011bn\u00e9 t\u0159i z\u00e1kroky na\u00a0necentrov\u00fdch pracovi\u0161t\u00edch.<\/p>\n

\u201eJejich text je velmi razantn\u00ed a \u0159\u00edk\u00e1, \u017ee se to d\u011blat nem\u00e1. Vzhledem k\u00a0mortalitn\u00edm a morbiditn\u00edm konsekvenc\u00edm se v\u00fdkony maj\u00ed prov\u00e1d\u011bt jen v\u00a0centrech. V sou\u010dasn\u00e9 dob\u011b jsou oba metodick\u00e9 pokyny fini\u0161ov\u00e1ny v r\u00e1mci ministerstva zdravotnictv\u00ed. A b\u011bhem n\u011bkolika t\u00fddn\u016f vyjdou ve v\u011bstn\u00edku,\u201c popisuje p\u0159edseda pracovn\u00ed skupiny pro centra specializovan\u00e9 p\u00e9\u010de ministerstva zdravotnictv\u00ed Tom\u00e1\u0161 Hauer.<\/p>\n

Odmlouv\u00e1n\u00ed i razantn\u00ed sn\u00ed\u017een\u00ed \u00fahrad<\/p>\n

Z\u00e1rove\u0148 u\u017e prob\u011bhla sch\u016fzka se zdravotn\u00edmi poji\u0161\u0165ovnami. Ty by na z\u00e1klad\u011b metodick\u00fdch pokyn\u016f m\u011bly v\u00a0druh\u00e9 polovin\u011b roku za\u010d\u00edt jednat s\u00a0pracovi\u0161ti, kter\u00e1 operace d\u011blaj\u00ed, a\u010dkoliv by nem\u011bla. A v\u00fdkony cht\u011bj\u00ed odsmlouv\u00e1vat.<\/p>\n

\u201eP\u0159edpokl\u00e1d\u00e1me, \u017ee na to poskytovatel\u00e9 usly\u0161\u00ed a operovat p\u0159estanou. Nebudou-li ale s odsmlouv\u00e1v\u00e1n\u00edm v\u00fdkon\u016f souhlasit, p\u0159ich\u00e1z\u00ed v \u00favahu nejtvrd\u0161\u00ed varianta, kterou je zru\u0161en\u00ed v\u00fdkon\u016f v\u00a0seznamu zdravotn\u00edch v\u00fdkon\u016f an block. T\u00edm p\u00e1dem dojde k\u00a0automatick\u00e9mu odsmlouv\u00e1n\u00ed v\u0161em poskytovatel\u016fm a nahrazen\u00ed nov\u00fdmi v\u00fdkony. Ty u\u017e budou m\u00edt podm\u00ednku prov\u00e1d\u011bn\u00ed jen v\u00a0centrech vysoce specializovan\u00e9 p\u00e9\u010de. To je ale krok, po kter\u00e9m nechceme s\u00e1hnout,\u201c dod\u00e1v\u00e1 Hauer, podle kter\u00e9ho chce ministerstvo celou v\u011bc komunikovat s\u00a0odbornou ve\u0159ejnost\u00ed na kv\u011btnov\u00e9 Konferenci specializovan\u00e9 p\u00e9\u010de<\/a>.<\/p>\n

Mohlo by v\u00e1s zaj\u00edmat<\/p>\n


\n \"\"
\n <\/a><\/p>\n

\"\"Nemocnice, kde se prov\u00e1d\u011bj\u00ed resekce jater, podle po\u010dtu v\u00fdkon\u016f. Zdroj: Kancel\u00e1\u0159 zdravotn\u00edho poji\u0161t\u011bn\u00ed <\/p>\n

\"\"90denn\u00ed mortalita po resekci jater. Zdroj: Kancel\u00e1\u0159 zdravotn\u00edho poji\u0161t\u011bn\u00ed <\/p>\n

Doposud se ministerstvo sna\u017eilo omezovat v\u00fdkony mimo centra takzvan\u00fdm koeficientem centralizace. Ten sni\u017euje \u00fahradu za dan\u00fd hospitaliza\u010dn\u00ed p\u0159\u00edpad a\u017e o 50 %. Pro p\u0159\u00ed\u0161t\u00ed rok pak chce ve t\u0159ech v\u00fd\u0161e zm\u00edn\u011bn\u00fdch p\u0159\u00edpadech ministerstvo prosadit 75 %.<\/p>\n

\u201eTo u\u017e je opravdu velk\u00e1 incentiva, aby to ned\u011blali. St\u00e1le m\u00e1me v\u00a0syst\u00e9mu pracovi\u0161t\u011b, kter\u00e1 d\u011blaj\u00ed t\u0159i slinivky nebo dva j\u00edcny. A to opravdu nejde. Jde tak o dal\u0161\u00ed z\u00a0krok\u016f, kter\u00fd m\u00e1 v\u00e9st k\u00a0tomu, aby operativy zanechali,\u201c dod\u00e1v\u00e1 Hauer.<\/p>\n

\u010cekac\u00ed lh\u016fty se nesm\u00ed prodlou\u017eit<\/p>\n

Jak ministerstvo zvolilo oblasti, u nich\u017e chce nyn\u00ed centralizaci dot\u00e1hnout? \u201eM\u016f\u017eeme docentralizovat pouze to, co u\u017e m\u00e1 funk\u010dn\u00ed centra, kter\u00e1 n\u011bjakou dobu b\u011b\u017e\u00ed, nebo je p\u00e9\u010de jen velmi rezidu\u00e1ln\u011b nezcentralizovan\u00e1,\u201c na\u010drt\u00e1v\u00e1 Hauer.<\/p>\n

V\u00fdsledkem je \u0161est center pro resekce j\u00edcnu a 13 center na hepatopankreatobili\u00e1rn\u00ed chirurgii, kde se prov\u00e1d\u011bj\u00ed operace jater a slinivky (HPB centra). S\u00a0t\u011bmi ministerstvo zvl\u00e1dne individu\u00e1ln\u011b komunikovat, a z\u00e1rove\u0148 nen\u00ed po\u010det necentralizovan\u00fdch v\u00fdkon\u016f tak vysok\u00fd, aby je centra nezvl\u00e1dla p\u0159evz\u00edt.<\/p>\n

\u201eNesm\u00ed se toti\u017e st\u00e1t, \u017ee by to prodlou\u017eilo objednac\u00ed doby k\u00a0operac\u00edm. U slinivek a jater zb\u00fdv\u00e1 z\u00a0hlediska necentrov\u00fdch operac\u00ed asi 350 pacient\u016f ro\u010dn\u011b, co\u017e znamen\u00e1 zhruba dva a p\u016fl pacienta na centrum za m\u011bs\u00edc nav\u00edc. \u0158editel\u00e9 centrov\u00fdch nemocnic maj\u00ed 20. dubna na spole\u010dn\u00e9 sch\u016fzi garantovat, \u017ee pacienty pojmou \u2013 nemocnice mus\u00ed vytvo\u0159it prostor,\u201c popisuje Hauer.<\/p>\n

J\u00edcn\u016f se mimo centra odoperovalo pouze 26. Center je \u0161est v\u00a0osmi nemocnic\u00edch, tak\u017ee by nem\u011bla m\u00edt probl\u00e9m tyto z\u00e1kroky p\u0159evz\u00edt.<\/p>\n

Mal\u00e1 centra n\u011bkdy vy\u0159azuj\u00ed rizikov\u00e9 pacienty<\/p>\n

Ministerstvo se z\u00e1rove\u0148 p\u0159i volb\u011b centralizovan\u00fdch z\u00e1krok\u016f \u0159\u00eddilo t\u00edm, \u017ee vy\u0161\u0161\u00ed po\u010det v\u00fdkon\u016f je prokazateln\u011b sv\u00e1zan\u00fd s\u00a0lep\u0161\u00edmi v\u00fdsledky. V\u00a0tomto ohledu ov\u0161em mohou b\u00fdt indik\u00e1tory kvality v\u00a0podob\u011b mortality v\u00a0\u010desk\u00fdch nemocnic\u00edch trochu matouc\u00ed. Zat\u00edmco u resekc\u00ed pankreatu a jater je toti\u017e jasn\u00fd rozd\u00edl mezi maloobjemov\u00fdmi a velkoobjemov\u00fdmi pracovi\u0161ti, u j\u00edcnu tento trend p\u0159estal b\u00fdt vid\u011bt.<\/p>\n

\"\"Nemocnice, kde se prov\u00e1d\u011bj\u00ed resekce slinivky, podle po\u010dtu v\u00fdkon\u016f. Zdroj: Kancel\u00e1\u0159 zdravotn\u00edho poji\u0161t\u011bn\u00ed <\/p>\n

\"\"90denn\u00ed mortalita po resekci slinivky. Zdroj: Kancel\u00e1\u0159 zdravotn\u00edho poji\u0161t\u011bn\u00ed <\/p>\n

\u201eKdy\u017e nesledujete parametry, nemaj\u00ed pracovi\u0161t\u011b autokultiva\u010dn\u00ed prvek. Takov\u00e9 to: \u201aPozor, n\u011bkdo se d\u00edv\u00e1, jak to d\u011bl\u00e1m.\u2018 Ve chv\u00edli, kdy se to sleduje, v\u00edte, \u017ee si na \u010d\u00edsla mus\u00edte d\u00e1vat pozor. A kdy\u017e nejsou dobr\u00e1, mus\u00edte zd\u016fvodnit pro\u010d. My tak nap\u0159\u00edklad v\u00edme, \u017ee nejv\u011bt\u0161\u00ed pra\u017esk\u00e9 HPB centrum m\u00e1 relativn\u011b vysokou mortalitu. To ale neznamen\u00e1, \u017ee je \u0161patn\u00e9, ale \u017ee selektuje opravdu t\u011b\u017ek\u00e9 pacienty. Oproti tomu n\u011bkter\u00e1 mal\u00e1 centra v\u00a0\u00e9\u0159e m\u011b\u0159en\u00ed v\u00fdsledk\u016f, kdy mortalita rozhoduje, zda v\u00fdkony budou, nebo nebudou d\u011blat, vy\u0159azuj\u00ed z\u00a0operativy vysoce rizikov\u00e9 pacienty. Jen\u017ee to neznamen\u00e1, \u017ee je ode\u0161lou jinam, ale zkr\u00e1tka je nikdo neoperuje,\u201c vysv\u011btluje Hauer.<\/p>\n

Velk\u00e1 centra um\u00ed zvl\u00e1dat komplikace<\/p>\n

Tedy v\u00a0souhrnu: n\u011bkter\u00e1 men\u0161\u00ed pracovi\u0161t\u011b p\u0159iprav\u00ed o mo\u017enost operace pacienty, kter\u00fdm by t\u0159eba z\u00e1krok je\u0161t\u011b mohl zachr\u00e1nit \u017eivot. A v\u00a0centrech se zku\u0161enostmi by je byli ochotni operovat, proto\u017ee maj\u00ed i z\u00e1zem\u00ed pro \u0159e\u0161en\u00ed komplikac\u00ed.<\/p>\n

\u201eJsem interven\u010dn\u00ed angiolog a na Vinohradech \u010dasto \u0159e\u0161\u00edm krv\u00e1cen\u00ed a dal\u0161\u00ed probl\u00e9my po operac\u00edch slinivek a extr\u00e9mn\u011b rozs\u00e1hl\u00fdch v\u00fdkonech, \u0159ada pacient\u016f po operaci krv\u00e1c\u00ed. Takovou intervenci m\u016f\u017eete ud\u011blat jen tam, kde m\u00e1te interven\u010dn\u00edho angiologa nebo interven\u010dn\u00edho radiologa, kter\u00fd krv\u00e1cen\u00ed zastav\u00ed. Mortalita u takov\u00fdch pacient\u016f je pak n\u00edzk\u00e1, zat\u00edmco mortalita u pacient\u016f se stejn\u00fdm probl\u00e9mem, kter\u00e9 mus\u00edte revidovat otev\u0159en\u011b, proto\u017ee nem\u00e1te endovaskul\u00e1rn\u00ed servis, p\u0159esahuje 50 %,\u201c objas\u0148uje Hauer.<\/p>\n

Ve v\u00fdsledku tak ani data, kter\u00e1 nyn\u00ed m\u00e1me k\u00a0dispozici, nemusej\u00ed odr\u00e1\u017eet kvalitu p\u00e9\u010de. Nejspecializovan\u011bj\u0161\u00ed pracovi\u0161t\u011b toti\u017e operuj\u00ed i hrani\u010dn\u00ed pacienty, tak\u017ee mohou m\u00edt vy\u0161\u0161\u00ed mortalitu. Oproti tomu men\u0161\u00ed pracovi\u0161t\u011b si mohou vyb\u00edrat pacienty v lep\u0161\u00edm stavu. Mortalitu a morbiditu pak maj\u00ed logicky ni\u017e\u0161\u00ed. <\/p>\n

I to je jeden z\u00a0d\u016fvod\u016f, pro\u010d ministerstvo nezve\u0159ejnilo mortalitn\u00ed indik\u00e1tory na \u00farovni jednotliv\u00fdch nemocnic. Ka\u017ed\u00fd pacient si ale u\u017e te\u010f m\u016f\u017ee ov\u011b\u0159it<\/a>, kolik z\u00e1krok\u016f pracovi\u0161t\u011b prov\u00e1d\u011bj\u00ed \u2013 a vyhnout se t\u011bm, kter\u00e1 jich d\u011blaj\u00ed m\u00e1lo.<\/p>\n","protected":false},"excerpt":{"rendered":"V\u00a0\u010cesku m\u00e1me st\u00e1le nemocnice, kter\u00e9 prov\u00e1d\u011bj\u00ed dv\u011b, t\u0159i resekce slinivky ro\u010dn\u011b. V\u00fdsledkem t\u011bchto trofejn\u00edch v\u00fdkon\u016f je hazard se…\n","protected":false},"author":2,"featured_media":55290,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[19736,43,42,41,40,807,19737,19738,19739,19740,19741],"class_list":{"0":"post-55289","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-cesko","8":"tag-centralizace-pece","9":"tag-ceska-republika","10":"tag-cesko","11":"tag-czech-republic","12":"tag-czechia","13":"tag-onkologie","14":"tag-resekce-jater","15":"tag-resekce-jicnu","16":"tag-resekce-slinivky","17":"tag-tomas-hauer","18":"tag-uhrady"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@cz\/116407464432382176","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/cz\/wp-json\/wp\/v2\/posts\/55289","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/cz\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/cz\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/cz\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/cz\/wp-json\/wp\/v2\/comments?post=55289"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/cz\/wp-json\/wp\/v2\/posts\/55289\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/cz\/wp-json\/wp\/v2\/media\/55290"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/cz\/wp-json\/wp\/v2\/media?parent=55289"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/cz\/wp-json\/wp\/v2\/categories?post=55289"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/cz\/wp-json\/wp\/v2\/tags?post=55289"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}